Milne, Robert NEW YORK STATE DEPARTMENT OF HEALTH n 71
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Robert John Milne Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 10, 2015 / 48 War or Dates
i of Death Hospital, Institution or
ill, own or Village t�/}J Street Address Saratoga Hospital
.nner of Death X Natural C e Acc(( ent E Homicide 0 Suicide Undetermined Pending
❑ ❑Circumstances Investigation
Medical Certifier Name Mai
Nicol araban,rre qq�� ,,
ss / SC. ?I4o4i
t Certificate FiledDistrict Nu Re ter Num r
r Ci „Xown or Village t!, l' '7 56 l �o
14 Burial ' Date Cemetery or Crematory
April 14, 2015 Pine View Crematory
0 Entombment Address
';®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Date Cemetery Address
❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
IN
Permission is hereby granted to dispose of the human remains des i ed b asi d.
Date Issued /3/is Registrar of Vital Statistics
/� (signature)
District Number q3 p( Place 3e J- ,,� $�'kJ NZ 1) t is`
4,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 04/14/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
E
(section) ` (lot number) (grave number)
` Name of Sexton or Person in Charge of Premises
f,, s rt-
(please print)
r Signature ate "f-- Title Inb"vOr"
(over)
DOH-1555 (02/2004)